The inaugural post of Pattern Analysis described the “new geography” of the 33 medical schools that between 2002 and 2013 had been accredited by either LCME (15) or AOA/COCA (18) to recruit and enroll medical students. The second post raised the question, Where will the clinical faculty necessary to teach the students in these new schools come from? This is a particularly tangled problem because nearly all of these schools have declared their mission to be the training of primary care physicians to practice in underserved rural and urban areas. Yet it is an accepted article of faith, nationally, that there is already an insufficient supply of practicing primary care physicians. Recruiting significant numbers of them to teach in new as well as existing schools of medicine will further reduce the amount of primary care physician time available for patient care.

The interesting issues don’t stop there. An additional 15 allopathic schools have been proposed since the end of December 2011 and 12 “new and developing” osteopathic medical schools currently are listed by AOA/COCA. None of these schools have developed to the point where the accrediting bodies will permit any of them to recruit or accept students. To be sure, many of them are more than mere proposals, and the total number may include a passing fancy (or fantasy) or two. What I try to do here is to identify the purposes and forces driving the proposals and to associate the putative schools with them. That analysis will lend some clarity to the question of whether any of these proposed schools is likely to become an accredited school in a reasonable length of time, say before 2020.

The data analyzed here come mainly from two sources: the AAMC-CAS newsletter assembled and issued by Tony Mazzaschi; and the AOA/COCA report “New and Developing COMs and Campuses” updated through March 31, 2013. These sources were supplemented by my personal knowledge of California, Texas, and Virginia institutions in particular.

Excepting the fact that most of the proposed schools are located in the southern half of the country, there is no national pattern as there is with the newly accredited schools. The latter tend to be located in rural areas, where there is an acknowledged lack of primary care physicians and consequently an underserved population.

On the other hand, the locations of the proposed schools range from “somewhere in Kansas,” to small towns and cities, to a handful of metropolitan centers, to the established campuses of major university systems, some of which have had branch medical school campuses for years. The geographic distribution of the proposed schools looks like a scatter diagram with a correlation coefficient of zero.

An unusual characteristic of two of the proposed allopathic schools (Palm Beach and California Northstate) is that they are for-profit organizations. Although there is at least one for-profit osteopathic school, LCME has never accredited a for-profit school, but is showing these two schools as being in “Applicant Status. “

Proposed Allopathic Schools

University system development of four-year medical schools either de novo or as expansions of branch campuses: University of California System, Merced; University of Colorado System, Colorado Springs; University of Indiana, Evansville; Louisiana State University System, Baton Rouge (with the Pennington Research Institute) and Lafayette (with University of Louisiana); University of Texas System, Austin and Rio Grande (exact location to be determined); and University of Nevada, Las Vegas.

Other than the Louisiana possibilities, which may be trial balloons in a state that already has three allopathic medical schools, and the Nevada proposal made by a Las Vegas physician member of the Board of Regents, the university system proposals are virtual certainties in five years or less. Colorado is funding the development of the Colorado Springs school at the rate of $3 million per year for the next 10 years. At 40, the Evansville branch of Indiana University School of Medicine is well established. The two Texas schools have university system, state government, and strong private-sector support. The University of California, Merced has a rudimentary administrative organization in place and its development will probably move forward more quickly now that the State’s fiscal difficulties seem to be under control.

This is a basket of unknowns. As noted earlier, LCME has never approved a proprietary school. Two are proposed and in Applicant Status. Henderson, Nevada, is a suburb of Las Vegas where there is a major branch of the University of Nevada Reno School of Medicine (and a proposal to make it a four-year school) and a Touro University College of Osteopathic Medicine. It seems that it would be difficult to shoehorn another four-year school into this milieu, although Las Vegas has become a metropolis of 2 million people.

Virginia has four allopathic and one osteopathic school now. Three more seems like an over-reaction. Carillon (MD) in Roanoke and Edward Via (DO) in Blacksburg are both responses to perceived unmet needs in southwest Virginia that have continued in spite of targeted efforts since the 1970s by the University of Virginia and Virginia Commonwealth University/Medical College of Virginia to increase the number of primary care physicians in the area. East Tennessee State University’s Quillen Medical School (in Johnson City 25 miles south of the Virginia state line) was also a 1970s response to the same problem in the bi-state area. Shenandoah’s proposal is being evaluated for feasibility. In my opinion, the Martinsville proposal will founder. King College is in Applicant Status with the LCME but may affiliate with East Tennessee.

Texas is an extremely wealthy state, but with seven public and one private medical school and two more public schools under development, it seems unlikely that a small sectarian institution like University of the Incarnate Word can develop a private allopathic school in the shadow of the UT system.

Liberty University has advanced from “Applicant” to “Pre-accreditation Status” and in all probability will add yet another medical school to Virginia’s five accredited institutions in another two to three years. Larkin became an Applicant in January 2013 and Indiana Wesleyan has been an Applicant since 2008. I would bet on Larkin.

Forecasting the future for this group of institutions is chancy at best. I would be surprised if half of them were accredited within the next three to six years. Monmouth, Cedar City, and Wausau are the most likely to emerge with accreditation.

How Many Is Enough?

Aside from the question of where the faculty will come from, one might also ask whether a 30 percent increase in the number of schools over 2002 is needed or desirable. The accrediting bodies focus only on quality and assiduously avoid the question of numbers, so any answer will have to come from other sources—political, economic, population health, business. Of course, these disparate sources rarely talk to each other and there is no more a coordinated plan for medical education in this country than there is a plan for how health care can be delivered humanely, professionally, and cost effectively to all.

—James E. Lewis, Ph.D., is an independent consultant to departments and schools of medicine, and teaching hospitals. He served as Deputy Dean for Operations and Vice President for Academic Administration, Mount Sinai School of Medicine and Medical Center, and Senior Executive Officer, Department of Medicine, University of Alabama at Birmingham. His monthly column, “Pattern Analysis,” appears on Wing of Zock. He can be reached at greegmt@me.com.

14 Responses to Proposed U.S. Allopathic and Osteopathic Medical Schools

Correction: On 6/13/13, Tony Mazzaschi’s newsletter noted that the LCME has granted “Applicant Status” to the College of Hericopolis, School of Medicine, Martinsville, VA. In my column, I indicated a doubtful future for this one. Clearly, I was wrong and want to be the first to note the fact.

A rather careless statement, I would say, especially when the new Martinsville medical school conforms to many of the high ideals and goals for medical education expressed elsewhere in this blog. Did the expressed opinion that it would “founder” have any real or perceived basis in fact? And it might be good to spell our name correctly, “College of Henricopolis School of Medicine,” taken from the name of the first established institution of higher education in Anglophone America, chartered in Virginia in 1618. Its motto is from Sir Francis Bacon, one of the original founders (pun intended), “Scientia ipsum potestas est,” usually rendered as “knowledge is power,” although we prefer “empowering.”

Wisconsin College of Osteopathic Medicine has moved again, now to Jefferson,WI – a town of 8,000 about 40 miles from both Milwaukee and Madison. It was first in Milwaukee before moving to Wassau.
I suspect your analysis of the likelihood of these institutions opening is largely correct. The AOA-COCA requires only a letter from the CEO to be listed as an Applicant. The LCME also requires $25,000. Homer Phillips was a proposal by Touro – which has 3 osteopathic schools & 1 alllopathic. However, it was shot down by everyone, including the Missouri Osteopathic Association. My understanding is that it has been officially abandoned. The two in Florida are probably pipe dreams in my judgment.
Indiana Wesleyan is a well-established university, and I think it is likely to open a school in metropolitatian Kansas City, Kansas within 5 years. I would not wager on any of the others, but Utah, New Jersey, Wisconsin & maybe Missouri are possible. [Liberty is a done deal, I am not including it.]
LCME just changed its accreditation standards to permit for-profit institutions. California Norhstate, which just obtained full pharmacy accreditation on its first try, and Incarnate Word which opened a optometry school a few years ago seem possibily viable to me. Just the best guess of one law professor with some concentration in health law and policy.

Thanks for your helpful and detailed update. It has only been a week since I did an exhaustive review of the LCME Standards dated July 1, 2013 and in effect for 2014-2015. Thus, their shift on the not-for-profit issue comes as a surprise to me. I appreciate your bringing it to my attention.

Failing a GPS your comments are vey helpful for tracking the others, only time will tell which ones stick and which fall by the wayside.

No mention of TOUROCOM expansion into Orange County, NY and LECOM Seton Hill Campus, I believe there are talks of a Rhode Island School of Osteopathic Medicine and Incarnate Word (San Antonio) looking for COCA approval ?

Thanks for your comment and new information. Excepting the total number of DO school campuses, the post didn’t allow space for discussing their locations. It has been 6 months since the post was published (7 since it was written) and it is not surprising that more DO (as well as MD) school campuses as well as schools and schools-to-be would come to light. I have in mind a complete update to post next spring. I monitor the COCA list of applicant and developing schools, but information like yours is always welcome.

Pre-accreditation with the AOA-COCA is the same as “Accredited, preliminary status” with LCME. It means that the school is accredited to recruit and admit a first year class. Liberty will open August 2014 – and they have a lot of money behind them and a clinical agreement with Centra Health.
LECOM has had a branch at Seton Hill for some time. About a year ago, I can find the exact date, Edward Via Virgina COM had a big ceremony at Auburn University Research Park. The EVVCOM people, the renowned Sports Orthopedic Surgeon Dr. James Andrews, the head of Community Health Systems hospital chain, and Auburn U Vice President, chamber of commerce, etc. were there. VCOM is supposed to open a complete 4-year campus there in 2015. I have heard nothing else, but they have already opened a medical and a dental school in Brandenton in addition to the original Blacksburg campus. I assuem this one is likely.
I do not totally understand it, but there is a symbiotic relationship between VCOM and Virginia Tech. VCOM is on the VPI website, and I understand that VCOM students have access to all services at Virgina Tech.
As I mentioned earlier, the AOA-COCA lets one becme an “applicant” based on a letter from the chief executive officer. Many, probably most of them do not make it. LCME requires $25,000.00 whiches reduces the pie in the sky people, although a number of non-public proposal still never come to fruition – at least that is my impression.

Thanks, again. I appreciate your knowledge of the COM plans and environment. VCOM is particularly interesting in light of the VA Tech-Carillion Health allopathic school in Roanoke which is in full operation. Via also has a COM in Spartanburg, SC, not far from the new allopathic school built around the Greenville (SC) hospital system. It is getting to be very much like the vendors’ pitch at a sports event: “You can’t know the players without a program.”

As I understand it, Edward Via left considerable money to found a medical school focused on primary care and rural practice, with the thought that Va. Tech would get the first shot at it. However, my understanding is that Tech suggested a DO school, which the executor – the son I think – had never heard of. Va. Tech was going to start a small, research and specialty medicine oriented school. Originally it was going to be a 5-year curriculum and give a M.D. & M.S. or M.D. and Ph.D. I think it is still somewhat that way. Orignally, Va Tech taught the first year basic science courses. However, exactly how this strange bird works I am not sure.
That is not a criticism, it is just very unusual. Michigan State seems to be the only place with real harmony and collaboration between allopathic and osteopathic medical education – and GME for that matter.

I am not sure about the DO/MD “harmony” at MSU. The original plan for a single basic science program and two different clinical programs never really worked (according to what I have been told) and within the past two years MSU’s School of Human Medicine has migrated from East Lansing to Grand Rapids and its Kalamazoo and Saginaw Valley clinical campuses have become independent medical schools at Western Michigan and Central Michigan Universities.

How Carillion evolves will be interesting to watch. The 50 year history suggests a primary care oriented school intended to meet the needs of southwestern Virginia. Today, Carillion’s web site states its aim is to graduate medical “thought leaders” and a new primary care oriented medical school is trying to emerge at Abingdon, Va about 80 miles southwest of Roanoke/Blacksburg. The latter is close enough to East Tennessee Medical School (Johnson City) that some “merger” discussions have been reported. Close to ETSU and targeted on rural Virginia, also, is the LCME applicant “College of Hericopolis” in Martinsville, Va.

And all of this with essentially no increase in GME positions since 1977 and none on the horizon.